Friday, April 15, 2011

Shoulder arthroplasty for arthritis: rehabilitation: care for the subscapularis.

A key to success after shoulder replacement for arthritis is the post operative exercise program. Click on this link: rehabilitation program to see our usual approach, although this may be modified in certain circumstances.

One of the key facts to keep in mind during the first 6 weeks after shoulder joint replacement is that the subscapularis muscle is cut off the front of the humerus early in the surgical operation to gain access to the joint. In the figure below, the subscapularis has been retracted to the right with two sutures.

Near the end of the case, repair sutures are placed through the bone.

Once the humeral implant is in position, the subcapularis is repaired to the previously placed sutures.

Although this repair is usually strong enough for Phase I of the early motion program, advanced healing of the repair is necessary before the shoulder can be stretched in passive external rotation or strengthened in active internal rotation. For this reason the two sets of exercises shown below are AVOIDED.

EXTERNAL ROTATION STRETCHING

INTERNAL ROTATION STRENGTHENING

Our resident Zlomislic demonstrated that the tension is not evenly distributed across the repair sutures and that the superior suture takes the preponderance of the load in the activities shown above - activities that put it at risk of pulling through the tendon.

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